variation in panctreatic ductal anatomy

Pancreatic

ducts • Pancreatic ducts (illustration) - Ganzer Fall bei Radiopaedia

Moore, C. Pancreatic ducts (illustration). Case study, Radiopaedia.org. (accessed on 24 Oct 2022) https://doi.org/10.53347/rID-76301 • CC by-nc-sa 3.0 (modified)

Partial

agenesis of the pancreas with superimposed chronic pancreatitis. MRCP (e, f) confirmed two cystic pancreatic lesions (arrows), the largest in the uncinate process, and visualized a normal-calibre pancreatic duct (thin arrows) draining into the Vaterian ampulla. Normal biliary tract.

www.eurorad.org • CC by-nc-sa-4.0

Secretin-stimulated

MR cholangiopancreatography: spectrum of findings in pancreatic diseases. a–c Normal findings. MRCP performed before secretin injection shows a normal main pancreatic duct (a), which demonstrates a regular dilation 3 min after secretin stimulation (b) and normal duodenal filling beyond the genu inferius after 15 min (c)

insightsimaging.springeropen.com • Open Access

Pancreatic

ducts • Pancreatic duct anatomic variation (diagram) - Ganzer Fall bei Radiopaedia

Hacking, C. Pancreatic duct anatomic variation (diagram). Case study, Radiopaedia.org. (accessed on 24 Oct 2022) https://doi.org/10.53347/rID-70381 • CC by-nc-sa 3.0 (modified)

Pancreatic

ducts • Pancreas divisum - Ganzer Fall bei Radiopaedia

Desai, P. Pancreas divisum. Case study, Radiopaedia.org. (accessed on 24 Oct 2022) https://doi.org/10.53347/rID-12105 • CC by-nc-sa 3.0 (modified)

Pancreatic

ducts • Pancreas divisum - Ganzer Fall bei Radiopaedia

Schubert, R. Pancreas divisum. Case study, Radiopaedia.org. (accessed on 24 Oct 2022) https://doi.org/10.53347/rID-14471 • CC by-nc-sa 3.0 (modified)

Pancreatic

ducts • Annular pancreas - Ganzer Fall bei Radiopaedia

Wang, M. Annular pancreas. Case study, Radiopaedia.org. (accessed on 24 Oct 2022) https://doi.org/10.53347/rID-13924 • CC by-nc-sa 3.0 (modified)

Pancreatic

ducts • Pancreas divisum - Ganzer Fall bei Radiopaedia

Schubert, R. Pancreas divisum. Case study, Radiopaedia.org. (accessed on 24 Oct 2022) https://doi.org/10.53347/rID-14519 • CC by-nc-sa 3.0 (modified)

Pancreatic

ducts • Bifid pancreatic tail - Ganzer Fall bei Radiopaedia

Schubert, R. Bifid pancreatic tail. Case study, Radiopaedia.org. (accessed on 24 Oct 2022) https://doi.org/10.53347/rID-16503 • CC by-nc-sa 3.0 (modified)

Pancreatic

ducts • Annular pancreas - Ganzer Fall bei Radiopaedia

Jha, P. Annular pancreas. Case study, Radiopaedia.org. (accessed on 24 Oct 2022) https://doi.org/10.53347/rID-16617 • CC by-nc-sa 3.0 (modified)

Pancreatic

ducts • Pancreas divisum - Ganzer Fall bei Radiopaedia

Gupta, P. Pancreas divisum. Case study, Radiopaedia.org. (accessed on 24 Oct 2022) https://doi.org/10.53347/rID-17397 • CC by-nc-sa 3.0 (modified)

Pancreatic

ducts • Pancreas divisum with Santorinicele - Ganzer Fall bei Radiopaedia

Saber, M. Pancreas divisum with Santorinicele. Case study, Radiopaedia.org. (accessed on 24 Oct 2022) https://doi.org/10.53347/rID-74709 • CC by-nc-sa 3.0 (modified)

Anatomical

pancreatic variants in intraductal papillary mucinous neoplasm patients: a cross-sectional study. Schematic and MRI images of non-MMPD type courses at the head of the pancreas. a Descending course. b Sigmoid course with a sigmoid curve. c Vertical course draining straight down

bmcgastroenterol.biomedcentral.com • CC-by-4.0

Anatomical

pancreatic variants in intraductal papillary mucinous neoplasm patients: a cross-sectional study. Meandering main pancreatic duct (MMPD) at the head of the pancreas. a Reverse-Z subtype C1 where the more upstream turn is tight and < 90° and the second turn is smoother and > 90°. b Reverse-Z subtype C2 where the more upstream turn is > 90° and the second turn is tight and < 90°. c Reverse-Z subtype C3 where there are two tight and < 90° turns in the horizontal direction along the same plane. d C3 subtype with the duct of Santorini which attaches to the right tight turn and drains into the minor papilla. e Loop-up configuration. f Loop-down configuration. g N-shape where the duct forms a deep notch. h N-shape where the ansa pancreatica attaches to the notch and drains into the minor papilla

bmcgastroenterol.biomedcentral.com • CC-by-4.0

Pancreatic

ducts • Pancreas divisum with dilated duct of Wirsung - Ganzer Fall bei Radiopaedia

Yang, N. Pancreas divisum with dilated duct of Wirsung. Case study, Radiopaedia.org. (accessed on 24 Oct 2022) https://doi.org/10.53347/rID-6726 • CC by-nc-sa 3.0 (modified)

Radiopaedia • CC-by-nc-sa 3.0 • de

The ductal embryology of the pancreas is moderately complicated, leading to a number of anatomical variants of the pancreatic ducts, many of which are clinically significant.

Gross anatomy

The normal arrangement is for the entire pancreas to be drained via a single duct, to the ampulla of Vater through the sphincter of Oddi.

The pancreatic duct extends from the tail to the head, and joins with the common bile duct at a 60 degree angle at the hepatopancreatic ampulla.

Conventional pancreatic ductal anatomy is described below.

Main pancreatic duct

portion of the dorsal duct proximal to the dorsal-ventral fusion point
drains at the ampulla of Vater
connects with the accessory pancreatic duct (of Santorini) (see below) if present

Nomenclature of the main pancreatic duct can be confusing :

based on distance from pancreatic head: proximal (head region); distal (tail region)
based on direction of secretion flow: proximal (tail region); distal (head region)
it may be best to refer to duct location by region, e.g. "duct in the head region" to avoid confusion

Pancreatic duct of Wirsung

distal portion of the main pancreatic duct
segment of the ventral duct between the dorsal-ventral fusion point and the major papilla
continuous with the main pancreatic duct proximally

Accessory pancreatic duct (of Santorini or Bernard)

portion of the dorsal duct distal to the dorsal-ventral fusion point
drains anterior and superior portion of the head
- in 70% of individuals drains to the minor papilla
- in 30% of individuals persists as a branch of the main pancreatic duct

Variant anatomy

Variants of the pancreas which result in ductal variations are covered in the pancreas article.

Pancreas divisum

A pancreas divisum is the most common variation of pancreatic duct formation and can account for up to 14% . It results from the failure of fusion of dorsal and ventral pancreatic anlages. As a result, the dorsal pancreatic duct drains most of the pancreatic glandular parenchyma via the minor papilla. Although controversial, this variant is considered as a cause of pancreatitis .

Pancreatic divisum can result in a santorinicele , which is a cystic dilatation of the distal dorsal duct, immediately proximal to the minor papilla .

Three subtypes are known :

type 1: classic, no connection at all; occurs in the majority of cases (~70%)
type 2: absent ventral duct, minor papilla drain all of pancreas while major papilla drains bile duct (~25%)
type 3: functional, filamentous or inadequate connection between dorsal and ventral ducts (~5%)

Meandering main pancreatic duct

Meandering main pancreatic duct (MMPD) comprises of a reverse Z-type and loop-type of pancreatic ducts.

Ansa pancreatica

Ansa pancreatica is a rare anatomic variation of the pancreatic ducts. It is a communication between the main pancreatic duct and the accessory pancreatic duct.